This section is from the book "A Practitioner's Handbook Of Materia Medica And Therapeutics", by Thos. S. Blair. Also available from Amazon: A Practitioner's handbook of Materia Medica and Therapeutics.
Scopolamin and Scopolamin Hydrobromate have long been employed more or less in ophthalmology in 1-10 to 1/8% solution, and in 1-60 gr. doses as hyoscine is employed. Chemically, it is similar to hyoscine.
The mode of administration is liable to change to some extent after more extended experience, but at present three hypodermic injections are given to secure anesthesia. Each dose contains from 1-120 to 1-64 grain of scopolamin and 1/8 grain of morphine. Give the first injection 2.0 hours before operating, the second 1.0 hours, and the final injection one-half hour before an incision is made, although the preparing of the patient may begin immediately after the third dose. Some cases require a little ether or chloroform, but the majority do not. There is usually six hours sleep from these doses. The present author doubts the safety of such anesthesia. The Preparations of Belladonna demand some attention. The U. S. P. solid extract is made from the leaves and can hardly be improved upon as a component of plasters, ointments, and for dispensing in pills and capsules. The average dose is 1-5 grain, or 10% in ointments. The fluidextract is also to be commended as carrying fully the medicinal elements of dried belladonna root. The Pharmacopceia directs I minim as the average single dose. The tincture is made from the leaves, and the average dose is given at 8 I. It presents no advantages over the fluidextract. The mother tincture is slightly more active than the U. S. P. tincture. A word of caution should be given concerning Lloyd's ec. tr. belladonna, since special development of this product has evolved a highly toxic preparation. It is a first-class extract, but even I minim doses are dangerous if long continued. It is usually given in doses of 1-20 to 1/2 I .The selection of the preparation of belladonna is an important matter, and none of them should be indiscriminately prescribed, and caution should be observed in combining belladonna with chemical substances. It is a very complex organic body, and its alkaloids need very careful handling. An old fluid-extract or one depositing a sediment should not be used. Atropine sulphate is generally to be preferred to atropine, since it is more stable. The present author takes a very conservative position as to its internal administration uncombined with morphine. Hyoscine and scopolamin are ofttimes used too recklessly. Especial caution should dominate their employment. Solutions of the alkaloids for hypodermic use should always be made up fresh. In large doses belladonna may be a very useful or may be a very dangerous drug. The limitations of this volume preclude entering at length upon the physiologic action. In general, it may be said that large doses are safe in cases of profound congestion and where stimulation of respiration can do no harm. It is well for young practicians to carefully study belladonna and the pathology of congestive states before risking the large dose. When employed to limit excessive secretion, it is often necessary to push the administration, as in severe nightsweats or to check the lacteal flow after a still-birth, or where the babe cannot be suckled. When used as an antispasmodic, as in whooping cough or in spasm of a sphincter muscle, it may be necessary to run up the dose. In moderate doses belladonna has a large sphere in antagonizing congestion, since it overcomes capillary stasis. A little reflection will suggest so wide a range of affections in which it is thus indicated that it would require many pages to enter into details. Do not prescribe belladonna for a blind list of diseases, but as indicated above, no difference what the disease may be, and it will be good therapeutics.
In small doses, frequently repeated, belladonna is useful in delirium, a drowsy state with flushed face and red eyes, difficulty in swallowing, pharyngitis and laryngitis, incontinence of urine, and in states in which the full physiologic action is not desired. It is not a remedy peculiarly adapted to small-dose medication, while minute doses are practically worthless except in the case of infants, to whom it seems peculiarly adapted. It also acts in very small doses upon the skin of blondes. Aconite given with or in alternation with belladonna most markedly intensifies its action in local congestions and in equalizing the general circulation. Thus given, very small doses of belladonna are effective. It has impressed me that the first decimal dilution of the drug is the weakest sectarian preparation of any value.